Efficacy of Allogeneic Hematopoietic Cell Transplantation in Human T Cell Lymphotropic Virus Type 1–Associated Adult T Cell Leukemia/Lymphoma: Results of a Systematic Review/Meta-Analysis

Madiha Iqbal, Tea Reljic, Farina Klocksieben, Taimur Sher, Ernesto Ayala, Hemant Murthy, Ali Bazarbachi, Ambuj Kumar, Mohamed A. Kharfan-Dabaja

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Human T cell lymphotropic virus type 1 (HTLV1)-associated adult T cell leukemia/lymphoma (ATLL) is an aggressive malignant disorder. Intensive conventional chemotherapy regimens and autologous hematopoietic cell transplantation (HCT) have failed to improve outcomes in ATLL. Allogeneic HCT (allo-HCT) is commonly offered as front-line consolidation despite lack of randomized controlled trials. We performed a comprehensive search of the medical literature using PubMed/Medline, EMBASE, and Cochrane reviews on September 10, 2018. We extracted data on clinical outcomes related to benefits (complete response [CR], overall survival [OS], and progression-free survival [PFS]) and harms (relapse and nonrelapse mortality [NRM]), independently by 2 authors. Our search strategy identified a total of 801 references. Nineteen studies (n = 2446 patients) were included in the systematic review; however, only 18 studies (n = 1767 patients) were included in the meta-analysis. Reduced intensity conditioning regimens were more commonly prescribed (52%). Bone marrow (50%) and peripheral blood (40%) were more frequently used as stem cell source. The pooled post-allografting CR, OS, and PFS rates were 73% (95% confidence interval [CI], 57% to 87%), 40% (95% CI, 33% to 46%), and 37% (95% CI, 27% to 48%), respectively. Pooled relapse and NRM rates were 36% (95% CI, 28% to 43%) and 29% (95% CI, 21% to 37%), respectively. The heterogeneity among the included studies was generally high. These results support the use of allo-HCT as an effective treatment for patients with ATLL, yielding pooled OS rates of 40%, but relapse still occurs in over one-third of cases. Future studies should evaluate strategies to help reduce relapse in patients with ATLL undergoing allo-HCT.

Original languageEnglish (US)
JournalBiology of Blood and Marrow Transplantation
DOIs
StatePublished - Jan 1 2019

Fingerprint

Adult T Cell Leukemia Lymphoma
Cell Transplantation
Meta-Analysis
Confidence Intervals
Viruses
T-Lymphocytes
Recurrence
Disease-Free Survival
Survival Rate
Human T-lymphotropic virus 1
Survival
Mortality
Homologous Transplantation
PubMed
Stem Cells
Randomized Controlled Trials
Bone Marrow
Drug Therapy

Keywords

  • Allogeneic hematopoietic cell transplantation
  • HTLV-1–associated adult T cell leukemia/lymphoma (ATLL)
  • Human T cell lymphotropic virus type 1 (HTLV-1)

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Efficacy of Allogeneic Hematopoietic Cell Transplantation in Human T Cell Lymphotropic Virus Type 1–Associated Adult T Cell Leukemia/Lymphoma : Results of a Systematic Review/Meta-Analysis. / Iqbal, Madiha; Reljic, Tea; Klocksieben, Farina; Sher, Taimur; Ayala, Ernesto; Murthy, Hemant; Bazarbachi, Ali; Kumar, Ambuj; Kharfan-Dabaja, Mohamed A.

In: Biology of Blood and Marrow Transplantation, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Human T cell lymphotropic virus type 1 (HTLV1)-associated adult T cell leukemia/lymphoma (ATLL) is an aggressive malignant disorder. Intensive conventional chemotherapy regimens and autologous hematopoietic cell transplantation (HCT) have failed to improve outcomes in ATLL. Allogeneic HCT (allo-HCT) is commonly offered as front-line consolidation despite lack of randomized controlled trials. We performed a comprehensive search of the medical literature using PubMed/Medline, EMBASE, and Cochrane reviews on September 10, 2018. We extracted data on clinical outcomes related to benefits (complete response [CR], overall survival [OS], and progression-free survival [PFS]) and harms (relapse and nonrelapse mortality [NRM]), independently by 2 authors. Our search strategy identified a total of 801 references. Nineteen studies (n = 2446 patients) were included in the systematic review; however, only 18 studies (n = 1767 patients) were included in the meta-analysis. Reduced intensity conditioning regimens were more commonly prescribed (52{\%}). Bone marrow (50{\%}) and peripheral blood (40{\%}) were more frequently used as stem cell source. The pooled post-allografting CR, OS, and PFS rates were 73{\%} (95{\%} confidence interval [CI], 57{\%} to 87{\%}), 40{\%} (95{\%} CI, 33{\%} to 46{\%}), and 37{\%} (95{\%} CI, 27{\%} to 48{\%}), respectively. Pooled relapse and NRM rates were 36{\%} (95{\%} CI, 28{\%} to 43{\%}) and 29{\%} (95{\%} CI, 21{\%} to 37{\%}), respectively. The heterogeneity among the included studies was generally high. These results support the use of allo-HCT as an effective treatment for patients with ATLL, yielding pooled OS rates of 40{\%}, but relapse still occurs in over one-third of cases. Future studies should evaluate strategies to help reduce relapse in patients with ATLL undergoing allo-HCT.",
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AU - Sher, Taimur

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